Baroness Masham of Ilton: My Lords, the Bill would not take away that choice; it would give them a choice still.

Baroness Cumberlege: My Lords, perhaps I can continue and then it will become clear. There are wards which, in extraordinary circumstances, such as when a major accident occurs, may have to be pressed into use for several days to cope with the disaster victims, requiring other patients to be moved. How could a hospital be forced to provide separate accommodation in those circumstances? In exceptional circumstances, through floods, fires and epidemics within the hospital, staff may have to move patients against their wishes. They are not fanciful situations but occur from time to time in hospitals throughout the land. If this Bill is enacted staff would be breaking the law and we would be placing them in an impossible situation.

The Bill would not only prove difficult to implement in emergencies; it would run counter to many positive developments in clinical care which are becoming routine; for example, the welcome trend towards day surgery where patients are admitted for hours rather than days. That is popular with both staff and patients and could be affected by applying the proposed rule rigidly to recovery areas. So could the use of observation wards and accident and emergency departments.

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As my noble friend Lady Seccombe clearly pointed out, to have a law with countless caveats to cope with seen and unforeseen circumstances would be wrong. My noble friend Lady Strange advocates legal tablets of stone. But there are severe disadvantages in rigidity and inflexibility. So, while the aims of the Bill are welcomed, the Government do not believe that legislation is the answer.

The Patient's Charter has always made clear that a patient's privacy, dignity, religious and cultural beliefs should be respected. Today, as has been said, the Secretary of State for Health launched a new charter for England. I agree with the noble Lord, Lord Stoddart, that groups such as the Patients' Association, the College of Health, the Women's Institute, and others, played an important role in placing this issue on the agenda.

In the course of producing the new Patient's Charter we undertook extensive consultation with patients' groups and the new standard in the charter is concrete evidence of the Government's desire to listen and to act on the views put to us. In the new charter we are strengthening our original national standard on privacy and dignity by introducing a new right and a new national standard. The charter states:

"Except in emergencies, you have a right to be told before you go into hospital whether it is planned to care for you in a ward for men or women. In all cases, you can expect single-sex washing and toilet facilities".

That point was raised by the noble Baroness, Lady Masham. The charter continues:

"If you would prefer to be cared for in single-sex accommodation (either a single-sex ward or 'bay' area within a larger ward which offers equal privacy) your wishes will be respected whenever possible. There may be some cases, particularly emergencies, where a hospital cannot provide single-sex accommodation. This is most likely to arise if you need to be looked after by a specialist nurse in an intensive care ward or in an observation unit. It is also possible that single-sex accommodation may not be available at the time proposed for your admission. If this is the case, you have the choice of accepting the immediate admission or of waiting for single-sex accommodation to become available".

The noble Baroness, Lady Masham, should not under-estimate the Patient's Charter. It will make a real difference. First, it will make the NHS look at how well it communicates with its patients. Does the admission letter say whether people will be in mixed-sex accommodation? If so, does it explain how privacy and dignity will be safeguarded? Does it offer the patient the opportunity to talk over his or her concerns before admission? The new right to prior notification will ensure that all these issues are addressed. It will also make trusts examine the lay-out of their accommodation and consider what modifications are needed and how it can be better managed. Separate washing and toilet facilities will have to be provided. Health authorities through their contracts will ensure that the requirements of the charter are rigorously monitored and met and the NHS Executive will continue to keep a close eye on its implementation.

I accept the point made by the noble Lord, Lord Stoddart, that many patients are very wary of criticising professional staff. But they should not feel hesitant in making their views known, in particular to the named

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nurse who is responsible for their care. The nurse should be in a position to offer reassurance and explain what will be done to protect their privacy. The charter is helping to create an NHS which is flexible and responsive to individual needs. Patients should not be afraid to put it to the test.

The noble Baroness, Lady Gould, and other Members of your Lordships' House, made the point that this is not just a women's issue. I agree with that. The issue is not just one in which women are interested. I should like to emphasise that the new right and standard in the charter applies to all patients, irrespective of gender and age.

Our experience of the original charter has shown that our aims can be implemented successfully without primary legislation. There has been no need for legislation to achieve goals on waiting times. Half of all admissions to hospital are immediate. But, since the original charter was launched, of those admitted from waiting lists almost half are now admitted within five weeks, and nearly three-quarters within three months. In September 1991, almost 44,000 patients were waiting over two years for treatment. Today there are virtually none. We have delivered on the 18-month waiting time guarantee for hip, knee and cataract operations. Nine out of 10 patients are now seen within 30 minutes of their appointment times. Nine out of 10 people are assessed in accident and emergency departments within five minutes.

Your Lordships will be aware that primary legislation does not always guarantee delivery of services. For example, for many years we have had legislation on the employment of disabled people, but its targets have never been achieved. The task of achieving change in the NHS often has to come through commitment of staff and better management. As a former regional chairman, I was involved in the original charter. I can assure your Lordships that it was embraced by the NHS. Huge strides have been made in every hospital and community trust to implement it, as our figures show.

Since my right honourable friend first raised this issue of mixed-sex wards in October last year, the debate has gathered momentum. Throughout we have listened, just as we did when people were most anxious about waiting times. We responded then, and we intend to respond now. We shall monitor the new charter standards very closely indeed.

The noble Baroness, Lady Jay, endorsed the view that patients are being considered as units of work to be counted and not to be treated as people. I strongly refute that. Doctors, nurses and sensitive managers give a quality service, and a personal service, taking immense care to consider the individual needs of people who are

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at their most vulnerable. I am sure that as a member of a health authority the noble Baroness will ensure that her contracts will deliver a quality service.

Baroness Jay of Paddington: My Lords, perhaps I may interrupt briefly to say that that is precisely why I spoke in some detail about the contracts.

Baroness Cumberlege: My Lords, then I am sure that the noble Baroness will recognise that the present system delivers the goods and that legislation is not necessary.

The noble Baroness was sceptical about the Patient's Charter, as was the noble Baroness, Lady Gould, who suggested that the charter will not be effective and that the words "wherever possible" will be used as an excuse. We have to be realistic about the implementation of the charter. The speed at which each NHS trust can act will depend on precise local circumstances. Some will be able to move faster than others. But there should be no doubt that the charter will give the green light to activity throughout the country to achieve the standard. Health authority purchasers will not accept "wherever possible" as an excuse for lack of action. Their response will be to press trusts to form plans and make headway.

The Government oppose the Bill on the grounds that it is unnecessary, but we share the anxieties which have prompted it. What the noble Lord's Bill highlights is as unacceptable to the Government as it is to him. We have to do even better. I have no doubt that we shall fulfil the demands of the Bill even more quickly than the noble Lord expects. But it would be wrong to saddle the service with a Bill which is unnecessary and which would impede the provision of quality clinical care, shackle management, introduce rigidity and work against the NHS as a whole.

This new Patient's Charter undertaking on single-sex wards will be fulfilled. It is important to this Governmentand to a convent girl. I believe that, on all sides of the House, we are totally committed; and, without a law, we shall deliver.

9.37 p.m.

Lord Stoddart of Swindon: My Lords, I should like to thank all those noble Lords who have taken part in the debate. I am conscious that I am the only man to have taken part, but I have been content and honoured to share the debate with the noble Baronesses who have spoken. However, despite my respect and liking for them, I would not want to share a hospital ward with them!

It has been a good debate. The subject has been thoroughly aired, and I thank all those who contributed.

The noble Baroness, Lady Seccombe, felt that this was an old person's issue. I can assure her that it is not. It is an issue which affects and troubles a complete cross-section of the populationyoung, old, male and femaleas we have heard from so many other speakers this evening. Although the Bill may need tidying up, I believe that we need it and that we should allow it to proceed into Committee.

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The noble Baroness, Lady Masham of Ilton, spoke about the Roman Catholic nun who was placed between two male footballers. That example underlines the problems which face us and emphasises the need for something rather stronger than the Patient's Charter. The noble Baroness also made the very reasonable and true point that Britain is virtually unique in imposing this system on National Health Service patients. The Government need to consider that point and their attitude towards the Bill.

My noble friend Lady Nicol said that there was nothing in past or present legislation to prevent this state of affairs arising. That is an important point. Why has there not been any legislation on this? Why were patients not considered when the existing legislation was drawn up? My noble friend also made the relevant point that patients are being treated as units of work rather than as patients. We must ensure that people are again treated as peopleas patients who require proper care and to be treated with dignity.

The noble Baroness, Lady Park of Monmouth, said that patients needed choice more than managers. That is absolutely right. The National Health Service is not for managers; it is for patients. Managers ought to be reminded of that, wherever they need reminding, and of the fact that their job is to provide for their patients. The noble Baroness also made the relevant point that what we wantand what we will get only under this Billis real choice, not "subliminal blackmail". I loved that phrase.

My noble friend Lady Gould emphasised the fact that the Bill constitutes no criticism of nursing and hospital staff. I want to echo that, because everybody who has written to me has referred in glowing terms to the nursing and medical staff who hold the nation's liking, love and respect. I am glad that my noble friend emphasised that. I am also glad that she referred to the multi-racial nature of our country. That is an important point. Indeed, a number of Jewish organisations have written to me to support the Bill.

The noble Baroness, Lady Strange, succinctly stated that all that we are trying to do is to enshrine government thinking into legislation. That is precisely what we are trying to do. In fact, we are trying to help the Government to be more effective.

The noble Baroness, Lady Robson of Kiddington, emphasised the vulnerability of ordinary people and their fear of causing offence, particularly when they are in a weak position. If they have legislation to back them, they will feel better able and more confident about making complaints, where complaints are justified.

I am pleased that my noble friend Lady Jay and I are on the same side tonight. We are on the same side most of the time. It just so happens that we sometimes cross each other on matters relating to AIDS and Sunday opening. As I said, I am glad that we are on the same side tonight and I thank her for her contribution. I am glad that my noble friend raised the point that there seems to have been no national policy or consultation with professional or patient organisations about this matter. The practice seems to

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have grown up without anybody knowing about it or taking proper action to prevent what has become a national scandal.

Finally, the Minister, who is a convent girl and understands the issue even better than I do, says that we do not need legislation. I want to re-emphasise that despite the existing charterpresumably the one we had yesterday but not todayand the paragraphs contained in it requiring patients to be treated with dignity, mixed-sex wards are growing and not diminishing. That is why we need legislation. I am glad to hear that Nightingale wards are to be used as single-sex wards onlyI hope that that will happen, because it is not happening at the momentand that mixed-sex wards will be phased out gradually.

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Even where there are bays it is important that both sexes are enabled to have privacy. There can still be embarrassing situations when men and women are being nursed in adjacent bays. Again, that has to be treated carefully. There are of courseI understand thissituations where perhaps single-sex accommodation cannot be provided. Those will be few and far between, and can be dealt with. I am sorry that the Government oppose the Bill. Despite that, I hope that the House will give it a Second Reading and that we can go on to further stages.

On Question, Bill read a second time, and committed to a Committee of the Whole House.